Anyone using ChatGPT for Insurance Appeals?
I'm three for three. Total game changer and timesaver:
Dear Insurance Review Committee,
I am writing to appeal the denial of coverage for radiofrequency lumbar denervation for my patient, who has experienced significant improvement in their low back pain following a series of medial branch blocks.
As you may be aware, medial branch blocks are a diagnostic procedure used to determine the source of low back pain. In my patient's case, the blocks provided an 80% improvement in their pain...
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Source: Student Doctor Network - December 22, 2022 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
Pain in neck and shoulder after posterior fusion
You guys know the patient
has had posterior fusion. Lots of scarring in the center of the spine. TPI dont work or only transient.
SCS is not an option d/t epidural scar likely.
Any of you guys do peripheral stim? What nerves are you blocking? Suprascapular or Supraclavicular or both? (Source: Student Doctor Network)
Source: Student Doctor Network - December 18, 2022 Category: Universities & Medical Training Authors: PinchandBurn Tags: Pain Medicine Source Type: forums
Therapeutic Disc injections for axial back pain
I am hearing some pain physicians have started doing intradiscal steroid injections with lidocaine for treatment of back pain. Most of us were not trained to pursue this even though the disc can be a source of back pain. What are your thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - December 6, 2022 Category: Universities & Medical Training Authors: nopain1234 Tags: Pain Medicine Source Type: forums
Zoster sine herpete
A previous patient came in with a new problem of severe right neck pain that wrapped around to the shoulder, about in a C4 distribution. Nothing on her C spine MRI to explain it, and her skin was hypersensitive to touch. Denied history of rash in the area but did have shingles several years ago on her face. Topicals weren’t helping and she got side effects with oral antineuropathics. She hadn’t had her shingles vaccine, so I told her to go ahead and get it, and that maybe it would help...
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Source: Student Doctor Network - December 5, 2022 Category: Universities & Medical Training Authors: callmeanesthesia Tags: Pain Medicine Source Type: forums
I told OpenAI to Prescribe treatment for chronic back pain in the style of Eminem
Fun link from r/medicine
ChatGPT
A conversational AI system that listens, learns, and challenges
chat.openai.com
“Prescribe treatment for chronic back pain in the style of Eminem”
First, I gotta give a shout out to my homie with chronic back pain
You need some relief, bro, you can't be living in constant strain
So here's the prescription, my man, listen up
No more popping pills, no more trying to tough it out
First, gotta stretch it out, get that spine aligned Yoga, Pilat...
Source: Student Doctor Network - December 4, 2022 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Not Interested In Fellowship
Hi everyone, I'm a PM&R resident and not interested in any fellowships, what are my job outlooks? Are Pain/Sports&Spine fellowships the only way to make a decent living? How would one get involved into subacute rehab? (Source: Student Doctor Network)
Source: Student Doctor Network - December 3, 2022 Category: Universities & Medical Training Authors: ofizzmizz Tags: PM&R Source Type: forums
neurosurgeons doing pain medicine injections
Holy crap!
I did anesthesia today in a surgicenter for two neurosurgeons who did a bunch of spinal injections.
I was blown away. One of the guys did two level bilateral transforaminal epidural steroid injections, all with an AP projection, no lateral projection - and 4 blobograms. He also did a lumbar sympathetic nerve block for leg pain (no contrast was used), and a bunch of facet injections with needle placements all over the place.
It is no wonder that insurance companies get...
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Source: Student Doctor Network - December 3, 2022 Category: Universities & Medical Training Authors: epidural man Tags: Pain Medicine Source Type: forums
Outreach Presentation Topic
Having to do a 10-15 minute presentation "on any topic I want" to a local, fairly affluent community of older folks. Any ideas on a good topic to go over? I was thinking maybe mid-thoracic back pain/"tech neck" since I've been seeing it a lot in them. I figure anything procedural would be lost on them. (Source: Student Doctor Network)
Source: Student Doctor Network - November 29, 2022 Category: Universities & Medical Training Authors: SgtThunderfistMD Tags: Pain Medicine Source Type: forums
Clinic visit prior to Kypho?
Patient with h/o of compression fxs comes in to clinic with acute on chronic back pain. Following day MRI shows acute thoracic compression fracture.
Question: Do I need to bring the patient back into clinic to review the MRI and order Kyphoplasty or can I just schedule and do an addendum to my most recent clinic note?
This patient has Medicare which does not require prior auth.
She has had prior Kypho with me this year and already indicated that she would want repeat procedure if new...
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Source: Student Doctor Network - November 23, 2022 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
Only one spinal level for RFA with commercial insurance?
Im in PA, and some pts have UPMC insurance. I have been getting denials for 2 level MBB and RFA by UPMC insurance and have looked into the policy and procedure manual for UPMC commercial insurance (again NOT medicaid), but insurance small business owners actually pay for.
Two things obviously jump out
1. No more than 1 level can be ablated in 12 months
2. Cannot ablate at level with spondylolisthesis.
HAHAHAHA this is absolutely laughable.
Has anyone else ran into anything like this? What...
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Source: Student Doctor Network - November 17, 2022 Category: Universities & Medical Training Authors: thecentral09 Tags: Pain Medicine Source Type: forums
Deciding between two jobs
I've been going back and forth between these two jobs. So thought I'd post this here and maybe get some insight.
Job 1 (current job):
-Private group practice
-$420k salary (note: I'm in a no income tax state) - no bonuses of any kind, just flat salary.
-7 hour work days
-See ~25 patients on clinic days, probably do ~40 fluoro procedures a week in office. Very efficient workflow.
-Moderate amount of chronic opioid prescribing, but all pretty low doses (<60 MME). Really dislike this aspect...
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Source: Student Doctor Network - November 16, 2022 Category: Universities & Medical Training Authors: Forwho Tags: Pain Medicine Source Type: forums
RFA doesn't last
So I'm sure this has happened to others before. Patient had 85% relief from bilateral lumbar RFA x2 months performed unilaterally 2 weeks apart. Pain then back to baseline. Exam consistent (facet loading +, same area, etc). What do you do? LCD guidelines state only 2 RFA's per 12 months. This is a Medicare patient so no prior auth required. I am hospital employed. I'm considering just going ahead and repeating it. Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - November 11, 2022 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
Best Saves Thread
Great case recently that qualifies as one of the best saves I’ve had over the past 10 years.
Healthy 20s female who’s family called EMS for an episode of syncope. Complained of severe mid upper back pain and shortness of breath. Rapidly decompensated in route and arrived periarrest looking near death and gasping for breaths. Initial vitals were BP 60/40s Sats 40s despite max NRB. Textbook symptom presentation so threw an US probe on the chest for a quick exam. Massively dilated RV actively...
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Source: Student Doctor Network - November 1, 2022 Category: Universities & Medical Training Authors: alpinism Tags: Emergency Medicine Source Type: forums
MRI with nerve sheath thickening - anyone seen this before?
50+yo with new axial only low back pain of several months. Born in Southeast Asian country.
I treated for facetogenic pain. Did MBBs and had ~70% relief but self-report limited by language/cultural barrier. In any case, pt decided to not move forward with RFA since was still "doing good".
MRI L-spine showed nonspecific nerve sheath thickening. Tried a lit search, couldn't come up with much. Radiologist said it could be seen in mixed connective tissue diseases.
Anyone seen this before? Would...
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Source: Student Doctor Network - October 27, 2022 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
contract- APP revenue percentage
Hello everyone,
I am a pain physician practicing in California, currently working for a private group. In process of renegotiating my contract. Initial term was 50:50 for collections for physician provided services. I supervise PA/NP and they see a big chunk of my patients, but I don't get any revenue back right now , but I will be negotiating soon. What would be a fair percentage should I ask for mid-level providers revenue? Note, I don't get any percentage of ancillary services...
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Source: Student Doctor Network - October 21, 2022 Category: Universities & Medical Training Authors: paindoc123 Tags: Pain Medicine Source Type: forums
